Basic Information
| Provider Information | |||||||||
| NPI: | 1508293481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DYNAMIC SPEECH SOLUTIONS, INC. | ||||||||
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| Address1: | 724 TOMLINSON TER | ||||||||
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| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327466306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076976901 | ||||||||
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| Address1: | 724 TOMLINSON TER | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327466306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076976901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2013 | ||||||||
| LastUpdateDate: | 10/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | WILKERSON | ||||||||
| AuthorizedOfficialFirstName: | VICTORIA | ||||||||
| AuthorizedOfficialMiddleName: | GLASGOW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4076976901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S., CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.